What to do

How to not get infected

Stay home

The United States is a big country, with 50 states, each handling this in a different way. Therefore, community spread is going to be occurring at different rates in different places. The best thing to do, if not required by your employer, is to stay home until this curve has sufficiently flattened.

• Do not dine out.
• Do not go to the movies - listen to the radio, watch TV, listen to podcasts, do puzzles, play board games, create an in-home disco.
• Do not go to church - use home rituals or streaming services.
• Do not go to work unless you must, and when you return have a routine for coming back so as not to bring the virus into your home.
• Do not go shopping for non-essentials.
• If you get restaurant food delivered, use a service that you can prepay and have the delivery person leave the food on the doorstep. Order well before you want to eat so you can isolate the food for a few hours, then heat it up if needed.
• When you go grocery shopping, wear gloves and isolate your purchases (and your gloves!) in a safe spot for a few hours before unpacking.
• Get outside! But keep walking. Say hi to people, get some social interaction, but get it in passing. Keep physical distance from others. Don’t stop and form groups. Make sure and wave to all the pets being walked.

Avoid crowds

It is best to stand at a distance from people. 6 feet or more is safest from infectious droplet spread. The higher your underlying risk factors (age, recent major surgery, cancer, immunocompromised, asthma, diabetes, etc), the more you should avoid crowds.

CDC has recommended that older adults ‘stay at home as much as possible’. But keep in mind that over the longer term, this isolation could have negative impacts on many people’s mental health. Cultivating meaningful relationships is a well established but under-appreciated determinant for all health outcomes. So DO see the people you love, but consider doing so via lower-risk activities. For instance, go for a walk outside with a smaller group of people rather than attending an event indoors. Go to the beach. Ride bikes. Golf. Picnic more. This is not going away in one week, so pace yourself.

Wash your hands

>20 seconds with soap and warm water. Here are great options of songs to sing to help you pass the time. Unlike some really stubborn viruses (like polio), viruses in the coronavirus family typically don’t survive longer than a few hours on most surfaces hard surfaces; though it can be up to days. Bleach or ethanol are more effective at decontaminating surfaces than they are disinfecting humanskin. So don’t hoard the hand sanitizer, that should be used only when you do not have any access to a soap and water sink. At a restaurant? Wash your hands. At school? Wash your hands. Vigorous handwashing with soap really is vital to reduce transmission; the awesome science of why is here. If you do nothing else at all, do wash your hands.

Do not touch your face

This is a way that the virus can enter the body. It is really hard to avoid; this is also why we advise staying home and avoiding crowds. It is also why top-down measures (event cancellation and imposed quarantine etc) work. The average person, even ones with baseline good hygiene, touch their faces constantly already without thinking about it. Especially with allergy season coming up, please keep this in mind.

Wear a facemask when in public

Context: facemask here means any “face coverings”, including scarves and bandanas.

If you absolutely have to venture into public where other people may be, buy a cloth mask or make your own as even US hospital chains are beginning to do.

Studies in previous years as well as COVID-19 ones in the last couple of months have shown for Influenza that a face covering may have a self-protection benefit. The viron (complete virus particle) that causes COVID-19 is roughly the same size as the Influenza viron at 125 nanometers and it has the same mechanisms of entering the human body, and the older studies showed facemask protected you to some degree from being infected with Influenza.

On April 3, the US Center for Disease Control (CDC), “recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission”. See the article on their site

On April 3, the World Health Organization’s top emergencies expert, Mike Ryan, during their daily news conference, said: “… The idea of using respiratory coverings or mouth coverings to prevent coughing and sneezing projecting disease into the environment and towards others … that in itself is not a bad idea …” (and more). There’s no page reflecting this change of policy yet. See the the video on youtube. Specifically, starting 59 mins and 20 seconds in.=======

Many hospital groups have asked for cloth masks to be made by people with sewing machines. Deaconess Health System on the March 20 - (PDF and Video) and Providence health services as part of their “100 million mask” initiative on March 21 - (Video).

By the third week of March, the countries of Vietnam, The Czech Republic (Czechia), and Slovakia are now operating a “wear a mask when in public” policy for their citizens and that includes homemade cloth masks. Austria is mandating that supermarket shoppers wear facemasks while shopping - see Reuters article. South Africa is encouraging facemask wearing too (since April 1).

Since April 2, the cities of New York and Los Angeles have mandated mask for people mixing in public.

Do not shake hands

Some fun alternatives are:

• hand over heart
• wakanda forever
• bow
• curtsey
• live long and prosper
• finger wag,
• princess wave
• jazz hands

…are best.

One awesome side benefit is that contactless greetings don’t even need to be agreed-upon in advance. Unlike handshakes, hugs, kisses, etc, there is no need to have an understood protocol. Do what works for you.

Do not touch public surfaces

Where possible, use knuckles rather than finger tips (e.g., for elevator buttons, light switches, etc.). Open doors with your hips rather than your hands. You may use your elbows to open door handles, if it’s an option. Use a sleeve to open a doorknob if needed.

Household practices and preparation

Do not hoard supplies

Items can easily become in short supply due to hoarding. Common products experiencing shortages include toilet paper, bottled water, and medical supplies.

Avoid purchasing large quantities of products, particularly those in short supply. Get what you need for 2-4 weeks. Leave the rest for others who need it. If you have a large quantity of surgical/N95 masks or other supplies consider donating it to groups in need such as healthcare providers or a local food pantry.

Keep your home clean and disinfect

You can find CDC Recommendations here.

Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks. If surfaces are dirty, clean them with detergent or soap and water prior to disinfection.

To make a bleach solution, mix 5 tablespoons (1/3 cup) bleach per gallon of water OR 4 teaspoons bleach per quart of water.

If you have the ability to do so, consider a ‘staging’ area for clean entry into your home. Remove shoes, outerwear. If you work in a high risk environment like a hospital, nursing home, etc, wash your clothes immediately and then dry them at high heat or at least dry in the sunshine. Wash hands right away. Isolate your mail, packages and purchases (including food) before bringing them into the house and leave them isolated a few hours at a minimum. If you are in an especially high risk group, you might want to consider leaving goods isolated a longer time (a few days) and avoid eating raw produce, and also decontaminating products that come into your house. The latest research shows that the virus can survive up to 4 hours on copper surfaces, up to 3 days on plastic and stainless steel, and up to 24 hours on cardboard.

Prepare a hot zone in your home in case someone falls ill

Prepare your home for the possibility you’ll need to isolate and care for an infected member of your household. Stock the room in advance with food that the infected person can consume with zero preparation and without face-to-face interaction with others. If you have a dedicated bathroom for the infected person, that is best. Realistically, given shortages you won’t have access to a surgical mask, but if you do have one, prioritize its use on the infected person rather than caretakers. Consider use of a cloth mask for the infected person as well as for the uninfected in the same household.

Do not mix cleaning products

These cleaning products become dangerous when mixed:

Products	Negative outcome
Bleach + Vinegar	Produce chlorine gas
Bleach + Ammonia	VERY toxic gas
Bleach + Alcohol	chloroform
Hydrogen Peroxide + Vinegar	corrosive acid

Sources: American Chemistry Society and Good Housekeeping

Shopping carefully

If you can afford to have groceries delivered, or can have someone shop for you, do so. Else, if you are elderly or immunocompromised go to the store first thing in the morning when things are less touched.

Some stores are extending their hours or dedicating special hour(s) for these vulnerable populations, more info here.

Arrange a “flu buddy”

Especially if you live by yourself. If your location is a hot spot, call each other daily. If anyone is sick, call them twice daily and have an agreed-upon contactless plan for delivering food, pain relief, and prescribed medications as well as for back up care of dependents.

This is a good opportunity to think about longer term versions of these care contingency plans.

What to do if you get sick

Do not go out if you are sick

A good idea — even if it is not coronavirus. Health systems need every available capacity. Don’t cause unnecessary panic. Don’t assume it is just a common cold. Definitely stay home if you have a fever or cough.

Call ahead to your doctor

Do NOT go directly to the hospital. More guidance from CDC here.

Call centers are understandably overwhelmed right now with the “worried well” so please try to leave those lines open for the people who really need them.

Sources: World Health Organization, Centers for Disease Control and Prevention

Know when to go to hospital

Compiled from this WHO report
Common symtoms

Only go to hospital when you have trouble breathing or you are short of breath (sitting, going to bathroom, walking, etc).

Gastrointestinal Symptoms (rare): Diarrhea, nausea, vomiting, or abdominal discomfort are all possible early symptoms. They may appear a couple of days BEFORE the respiratory symptoms.

Timeline

• Mild cases usually clear up in 7 days (no hospitalization).
• It can take 2-14 days for the first covid19 symptom to develop. 88% of them eventually have fever. For nearly half of the hospitalized patients, fever may not develop before you need to be admitted to hospital.
• By day 5, patients of preconditions may have trouble breathing (go to hospital).

Recovery time: (for all patients that develop pneumonia)

• Mild: a few days.
• Severe: 2-1/2 weeks.
• Critical (with ARDS): 30-40% fatal. Recovery could take months.

Symptom tracking apps:

• US: covidaware.me
• UK: covid.joinzoe.com
• CA: flatten.ca
• Japan: coronatracker.com

How to support your community

Cancel non-essential medical visits

Hospitals are hot spots for transmission; get your vaccinations at a pharmacy rather than at the doctor. Find ways to do your physical therapy at home if possible.

Telemedicine professionals, this is your time to save the day, for everyone’s benefit but especially those in rural areas who are hard hit and without easy access to medical care. https://doxy.me and https://vsee.com/clinic/ provide free HIPAA compliant video platforms for telehealth.

JHU is developing resources here for hospital staff and administrators; more info here.

Do not spread misinformation

Be informed, and do not spread rumors and speculation. Only promote factual information from reputable sources.

Do not be racist

Racist assumptions lead to racist behaviors. Racist behaviors divide us, and in this pandemic situation, definitely work against us. If we divide ourselves according to race, ethnicity, or nationality, the virus wins and we all lose, plain and simple. If we unite ourselves regardless of race, ethnicity, or nationality, the virus loses and we all win.

Be kind to others

At all times, be kind to each other and be mindful of other people’s worries. You may be in a low risk group and feel this is nothing to fret about, but your 80-year old neighbor or your friend with recent heart surgery may feel quite differently. Every person matters; no one is “expendable.”

Donate

Healthcare professionals are running short of N95 masks, gloves, and other personal protetive equipment. If you have a surpluss of these supplies, consider donating them. Consult your local hospital for instructions on how to do so.

Tips to reduce stress

Ignore “secret treatments” and home remedies

Be good to your body. Expect companies to capitalize on your fear. Don’t buy products that claim to protect or heal you at this point. Currently available products like ibuprofen and paracetamol can be useful to lessen some symptoms; however so far, nothing has been proven to do above random noise. Don’t believe individuals who say that crystals, essential oils, etc. have helped them; the folks sharing these products may have the best intentions, or they may be predatory. But the idea is the same: many patients spontaneously do get better on their own because most cases are mild and resolve without pharmaceutical intervention. Instead of worrying about remedies, eat good food. Exercise. Meditate. Rest. Don’t neglect your mental health and don’t use your anxiety as an excuse for poor behavior towards others.

Do not binge on news or social media

Once you’ve done everything you can, step back. Way back. Watch something funny. Read a good book. Learn an instrument. Garden. Hug your kid. Call your mom. Hug your mom. Call your kid. Be present. Take this moment to be grateful that you are alive on this amazing planet. We are in this together; look after each other.

Myths

It’s just the flu.

It isn’t! The severity is more similar to pneumonia. Many patients require respiratory support. It is also more contagious than the common flu. (source)

I’m young and healthy so I don’t need to care.

Young and healthy people are generally less likely to die if infected, but this is not the point! Treatable conditions easily become deadly if the health system collapses. We are not equipped to handle hundreds or thousands of respiratory patients at the same time. In places where the outbreak is full-blown, the medical facilities are completely overwhelmed. Patients are in hallways and gymnasiums. Doctors are being forced to ration limited resources like ventilators, oxygen, and even basic supplies like surgical masks and gloves. You might be lucky, but it will likely be at the expense of others in your community.

There are no infections near me.

There are almost definitely infections near you! But you cannot see them yet because there is a two week delay between the time of infection and when someone shows symptoms. During that time, the infected person is contagious and spreading the infection. For every single diagnosed case of COVID-19, there are likely hundreds of undiagnosed cases. For this reason, our only chance to avoid a massive public health disaster is if we take preventative measures before we see it everywhere. (source)

I cannot afford to stay home or close my business.

This is a public health and economic crisis. Everyone is impacted. All the evidence indicates that the pandemic will force most businesses to close soon whether we want to or not. Ideally, public officials will take decisive steps to mandate social distancing as it is currently one of the only tools available to flatten the curve of infections and save lives. We can’t opt out of this pandemic, but we can opt out of unnecessary risk of infection. If a tsunami was coming towards your town, would you complain about the economic cost of evacuating? This outbreak is an invisible tsunami, but unlike the countries where it hit first, we have advanced warning. The US wasted much of that head start with inaction, but one of the lessons becoming increasingly clear is that every single day counts.

The media is overblowing this. People are just panicking.

There has been a lot of misinformation and the media is predisposed to fearmongering. But this does not change the fact that the situation is very serious. Panicking is dangerous and unproductive, but so is ignorance and inaction.

There’s no point in staying home because some people aren’t.

The goal of social distancing is to slow the rate of infections and more is better, but it is not “all or nothing.” In the context of an exponential growth pattern, even small reductions have large effects. If the well-being of your greater community doesn’t motivate you, remember that you are risking infecting yourself and your family.